Publication

Costs and Consequences of Additional Chest X-Ray in a Tuberculosis Prevention Program in Botswana

Samandari, T., Bishai, D., Luteijn, M., Mosimaneotsile, B., Motsamai, O., Postma, M. & Hubben, G., 15-Apr-2011, In : American Journal of Respiratory and Critical Care Medicine. 183, 8, p. 1103-1111 9 p.

Research output: Contribution to journalArticleAcademicpeer-review

APA

Samandari, T., Bishai, D., Luteijn, M., Mosimaneotsile, B., Motsamai, O., Postma, M., & Hubben, G. (2011). Costs and Consequences of Additional Chest X-Ray in a Tuberculosis Prevention Program in Botswana. American Journal of Respiratory and Critical Care Medicine, 183(8), 1103-1111. https://doi.org/10.1164/rccm.201004-0620OC

Author

Samandari, Taraz ; Bishai, David ; Luteijn, Michiel ; Mosimaneotsile, Barudi ; Motsamai, Oaitse ; Postma, Maarten ; Hubben, Gijs. / Costs and Consequences of Additional Chest X-Ray in a Tuberculosis Prevention Program in Botswana. In: American Journal of Respiratory and Critical Care Medicine. 2011 ; Vol. 183, No. 8. pp. 1103-1111.

Harvard

Samandari, T, Bishai, D, Luteijn, M, Mosimaneotsile, B, Motsamai, O, Postma, M & Hubben, G 2011, 'Costs and Consequences of Additional Chest X-Ray in a Tuberculosis Prevention Program in Botswana', American Journal of Respiratory and Critical Care Medicine, vol. 183, no. 8, pp. 1103-1111. https://doi.org/10.1164/rccm.201004-0620OC

Standard

Costs and Consequences of Additional Chest X-Ray in a Tuberculosis Prevention Program in Botswana. / Samandari, Taraz; Bishai, David; Luteijn, Michiel; Mosimaneotsile, Barudi; Motsamai, Oaitse; Postma, Maarten; Hubben, Gijs.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 183, No. 8, 15.04.2011, p. 1103-1111.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

Samandari T, Bishai D, Luteijn M, Mosimaneotsile B, Motsamai O, Postma M et al. Costs and Consequences of Additional Chest X-Ray in a Tuberculosis Prevention Program in Botswana. American Journal of Respiratory and Critical Care Medicine. 2011 Apr 15;183(8):1103-1111. https://doi.org/10.1164/rccm.201004-0620OC


BibTeX

@article{e9a9602c0e8041e8bb8a8b2500fdbcc2,
title = "Costs and Consequences of Additional Chest X-Ray in a Tuberculosis Prevention Program in Botswana",
abstract = "Rationale: Isoniazid preventive therapy is effective in reducing the risk of tuberculosis (TB) in persons living with HIV (PLWH); however, screening must exclude TB disease before initiating therapy. Symptom screening alone may be insufficient to exclude TB disease in PLWH because some PLWH with TB disease have no symptoms. The addition of chest radiography (CXR) may improve disease detection.Objectives: The objective of the present analysis was to compare the costs and effects of the addition of CXR to the symptom screening process against the costs and effects of symptom screening alone.Methods: Using data from Botswana, a decision analytic model was used to compare a {"}Symptomonly'' policy against a {"}Symptom+CXR'' policy. The outcomes of interest were cost, death, and isoniazid-and multidrug-resistant TB in a hypothetical cohort of 10,000 PLWH. Measurements and MainResults: The Symptom+CXR policy prevented 16 isoniazid-and 0.3 multidrug-resistant TB cases; however, because of attrition from the screening process, there were 98 excess cases of TB, 15 excess deaths, and an additional cost of U. S. $127,100. The Symptom+CXR policy reduced deaths only if attrition was close to zero; however, to eliminate attrition the cost would be U. S. $2.8 million per death averted. These findings did not change in best-and worst-case scenario analyses.Conclusions: In Botswana, a policy with symptom screening only preceding isoniazid-preventive therapy initiation prevents more TB and TB-related deaths, and uses fewer resources, than a policy that uses both CXR and symptom screening.",
keywords = "tuberculosis, isoniazid preventive therapy, cost-effectiveness, human immunodeficiency virus, chest X-ray, HIV-INFECTED ADULTS, HUMAN-IMMUNODEFICIENCY-VIRUS, ACTIVE ANTIRETROVIRAL THERAPY, SOUTH-AFRICA, RESISTANT TUBERCULOSIS, RISK-FACTORS, GOLD MINERS, COHORT, UGANDA, ABNORMALITIES",
author = "Taraz Samandari and David Bishai and Michiel Luteijn and Barudi Mosimaneotsile and Oaitse Motsamai and Maarten Postma and Gijs Hubben",
year = "2011",
month = "4",
day = "15",
doi = "10.1164/rccm.201004-0620OC",
language = "English",
volume = "183",
pages = "1103--1111",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "AMER THORACIC SOC",
number = "8",

}

RIS

TY - JOUR

T1 - Costs and Consequences of Additional Chest X-Ray in a Tuberculosis Prevention Program in Botswana

AU - Samandari, Taraz

AU - Bishai, David

AU - Luteijn, Michiel

AU - Mosimaneotsile, Barudi

AU - Motsamai, Oaitse

AU - Postma, Maarten

AU - Hubben, Gijs

PY - 2011/4/15

Y1 - 2011/4/15

N2 - Rationale: Isoniazid preventive therapy is effective in reducing the risk of tuberculosis (TB) in persons living with HIV (PLWH); however, screening must exclude TB disease before initiating therapy. Symptom screening alone may be insufficient to exclude TB disease in PLWH because some PLWH with TB disease have no symptoms. The addition of chest radiography (CXR) may improve disease detection.Objectives: The objective of the present analysis was to compare the costs and effects of the addition of CXR to the symptom screening process against the costs and effects of symptom screening alone.Methods: Using data from Botswana, a decision analytic model was used to compare a "Symptomonly'' policy against a "Symptom+CXR'' policy. The outcomes of interest were cost, death, and isoniazid-and multidrug-resistant TB in a hypothetical cohort of 10,000 PLWH. Measurements and MainResults: The Symptom+CXR policy prevented 16 isoniazid-and 0.3 multidrug-resistant TB cases; however, because of attrition from the screening process, there were 98 excess cases of TB, 15 excess deaths, and an additional cost of U. S. $127,100. The Symptom+CXR policy reduced deaths only if attrition was close to zero; however, to eliminate attrition the cost would be U. S. $2.8 million per death averted. These findings did not change in best-and worst-case scenario analyses.Conclusions: In Botswana, a policy with symptom screening only preceding isoniazid-preventive therapy initiation prevents more TB and TB-related deaths, and uses fewer resources, than a policy that uses both CXR and symptom screening.

AB - Rationale: Isoniazid preventive therapy is effective in reducing the risk of tuberculosis (TB) in persons living with HIV (PLWH); however, screening must exclude TB disease before initiating therapy. Symptom screening alone may be insufficient to exclude TB disease in PLWH because some PLWH with TB disease have no symptoms. The addition of chest radiography (CXR) may improve disease detection.Objectives: The objective of the present analysis was to compare the costs and effects of the addition of CXR to the symptom screening process against the costs and effects of symptom screening alone.Methods: Using data from Botswana, a decision analytic model was used to compare a "Symptomonly'' policy against a "Symptom+CXR'' policy. The outcomes of interest were cost, death, and isoniazid-and multidrug-resistant TB in a hypothetical cohort of 10,000 PLWH. Measurements and MainResults: The Symptom+CXR policy prevented 16 isoniazid-and 0.3 multidrug-resistant TB cases; however, because of attrition from the screening process, there were 98 excess cases of TB, 15 excess deaths, and an additional cost of U. S. $127,100. The Symptom+CXR policy reduced deaths only if attrition was close to zero; however, to eliminate attrition the cost would be U. S. $2.8 million per death averted. These findings did not change in best-and worst-case scenario analyses.Conclusions: In Botswana, a policy with symptom screening only preceding isoniazid-preventive therapy initiation prevents more TB and TB-related deaths, and uses fewer resources, than a policy that uses both CXR and symptom screening.

KW - tuberculosis

KW - isoniazid preventive therapy

KW - cost-effectiveness

KW - human immunodeficiency virus

KW - chest X-ray

KW - HIV-INFECTED ADULTS

KW - HUMAN-IMMUNODEFICIENCY-VIRUS

KW - ACTIVE ANTIRETROVIRAL THERAPY

KW - SOUTH-AFRICA

KW - RESISTANT TUBERCULOSIS

KW - RISK-FACTORS

KW - GOLD MINERS

KW - COHORT

KW - UGANDA

KW - ABNORMALITIES

U2 - 10.1164/rccm.201004-0620OC

DO - 10.1164/rccm.201004-0620OC

M3 - Article

VL - 183

SP - 1103

EP - 1111

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 8

ER -

ID: 5322213